Pneumomediastinum Following Intubation in COVID-19 Patients: A Case Series

Anaesthesia. 2020 May 6;10.1111/anae.15113. doi: 10.1111/anae.15113. Online ahead of print.

Abstract

The number of patients requiring tracheal intubation rose dramatically in March and April 2020 with the COVID-19 outbreak. Our thoracic surgery department has seen an increased incidence of severe pneumomediastinum referred for surgical opinion in intubated patients with COVID-19 pneumonitis. Here we present a series of five patients with severe pneumomediastinum requiring decompression therapy over a 7-day period in the current COVID-19 outbreak. We hypothesise that the mechanism for this is the aggressive disease pathophysiology with an increased risk of alveolar damage and tracheobronchial injury, along with the use of larger-bore tracheal tubes and higher ventilation pressures. We present this case series in order to highlight the increased risk of this potentially life-threatening complication among the COVID-19 patient cohort and offer guidance for its management to critical care physicians.

Keywords: COVID-19; acute respiratory distress syndrome; pneumomediastinum; surgical emphysema; tracheal injury.